【摘要】 目的分析成人退行性脊柱侧凸(ADS)顶椎区域腰椎多裂肌的萎缩情况(LMA),并探讨其与冠状位Cobb角(CA)的相关性。方法回顾性分析2016年6月至2017年5月在吉林大学中日联谊医院诊治的64例ADS患者的临床资料。利用Goutallier分级评价磁共振成像(MRI)T2加权像轴位的顶椎区域凹凸侧的多裂肌萎缩LMA的分布情况。同时,采用站立位腰椎正侧位X线平片上测量脊柱冠状面和矢状面参数,包括冠状位Cobb角(CA)、腰椎前凸角(LL)和骶骨倾斜角(SS)。采用配对t检验比较顶椎区域凹凸侧的LMA差异。采用单因素及多因素分析探讨冠状位CA与年龄、性别、LMA、LL及SS的相关性。结果符合纳入标准的ADS患者共64例,其中男30例,女34例,平均年龄65.7±6.1岁。凹侧多裂肌萎缩LMA的平均分级评分为2.7±0.7,显著高于凸侧的0.8±0.5,P<0.001;腰椎正侧位X线上测量CA、LL和SS分别为(15.3°±3.6°)、(29.7°±12.5°)和(27.3°±7.5°)。单因素相关性分析结果显示:CA与凹侧LMA及凸侧LMA呈显著正性相关(P<0.001);CA与LL和SS呈显著负性相关(P<0.001);而CA与性别、年龄无显著相关性(P>0.05)。进一步多因素回归分析显示:CA与凹侧LMA呈显著正性相关,与LL呈显著负相关,回归系数B分别为2.33和-0.05,P<0.05。结论成人退行性脊柱侧凸的顶椎区域多裂肌萎缩以凹侧为重,与侧凸角度密切相关,为全面评价ADS退变程度及理解各影像参数之间关联提供参考。更多还原

【Abstract】 Objective To analyze the lumbar multifidus muscle atrophy(LMA)in the apical region of adult degenerative scoliosis(ADS),and further explore the correlation between LMA and coronal Cobb angle(CA).Methods The medical records of 64 patients with ADS who were treated in China-Japan Union Hospital of Jilin University from June2016 to may 2017 were retrospectively reviewed.LMA was evaluated on axial T2-weighted magnetic resonance imaging(MRI)at the apical region of adult degenerative scoliosis,and coronal and sagittal parameters were measured on standing anteroposterior and lateral radiographs of the lumbar spine.The correlation between coronary CA and age,sex,LMA,LL and SS was investigated by univariate and multivariate linear regression analysis.Results This study included 64 ADS patients(30 males,34 females)with a mean age of 65.7±6.1 years(range,44-78 years).The mean LMA grade of concave side was 2.72±0.7(range 2-4),which was significantly higher than that of convex side 0.83±0.5(range 0-2),P<0.001.Mean coronal CA was 15.3°±3.6°(range,10.1-21.7°),LL was 29.7°±12.5°(range,10.2°-52.3°),and SS was 27.3°±7.5°(range,13°-43°).Univariate regression analysis showed that CA was positively correlated with concave LMA and convex LMA(P<0.001);CA was negatively correlated with LL and SS(P<0.001);There was no correlation between CA with gender and age.Further multivariate linear regression analysis showed that Ca was significantly positively correlated with the concave LMA,and negatively correlated with LL,with coefficients of2.33,-0.05,P<0.05.Conclusion LMA was significnalty increased on the concave side vs.the convex side.LL and concave LMA are closely related to coronal Cobb angle,which can provide a reference for comprehensive evaluation of the degeneration degree of ADS and understanding the correlation between imaging parameters.更多还原